Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 173, Issue 1, Pages 26-37Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwq319
Keywords
breast neoplasms; education; incidence; reproductive history; risk factors
Categories
Funding
- Fondation pour la Recherche Medicale
- European Commission [EUROCADET:SP23-CT-2005-006528, QLG1-CT-2001-01049, 513943]
- European Commission: Public Health and Consumer Protection Directorate
- European Commission (SANCO)
- Ligue contre le Cancer (France)
- Societe 3M (France)
- Mutuelle Generale de l'Education Nationale
- Institut National de la Sante et de la Recherche Medicale
- German Cancer Aid
- German Cancer Research Center
- German Federal Ministry of Education and Research
- Danish Cancer Society
- Red Tematica de Investigacion Cooperativa de Centros de Cancer [C03/10]
- Murcia
- Navarra
- Asturias
- Pais Vasco y Andalucia, Spain
- Cancer Research United Kingdom
- Medical Research Council, United Kingdom
- Stroke Association, United Kingdom
- British Heart Foundation
- Department of Health, United Kingdom
- Food Standards Agency, United Kingdom
- Wellcome Trust, United Kingdom
- Greek Ministry of Health
- Stavros Niarchos Foundation
- Hellenic Health Foundation
- Italian Association for Research on Cancer
- Dutch Ministry of Public Health, Welfare and Sports
- Dutch Ministry of Health
- Dutch Prevention Funds
- LK Research Funds
- Dutch Zorg Onderzoek Nederland
- World Cancer Research Fund
- Swedish Cancer Society
- Swedish Scientific Council
- Regional Government of Vasterbotten and Skane, Sweden
- Norwegian Cancer Society
- Foundation to Promote Research into Functional Vitamin B12 Deficiency, Norway
- ECNIS
- Medical Research Council [G1000143, G0401527, G0801056B] Funding Source: researchfish
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The authors investigated the role of known risk factors in educational differences in breast cancer incidence. Analyses were based on the European Prospective Investigation Into Cancer and Nutrition and included 242,095 women, 433 cases of in situ breast cancer, and 4,469 cases of invasive breast cancer. Reproductive history (age at first full-term pregnancy and parity), exposure to endogenous and exogenous hormones, height, and health behaviors were accounted for in the analyses. Relative indices of inequality (RII) for education were estimated using Cox regression models. A higher risk of invasive breast cancer was found among women with higher levels of education (RII = 1.22, 95% confidence interval (CI): 1.09, 1.37). This association was not observed among nulliparous women (RII = 1.13, 95% CI: 0.84, 1.52). Inequalities in breast cancer incidence decreased substantially after adjusting for reproductive history (RII = 1.11, 95% CI: 0.98, 1.25), with most of the association being explained by age at first full-term pregnancy. Each other risk factor explained a small additional part of the inequalities in breast cancer incidence. Height accounted for most of the remaining differences in incidence. After adjusting for all known risk factors, the authors found no association between education level and risk of invasive breast cancer. Inequalities in incidence were more pronounced for in situ breast cancer, and those inequalities remained after adjustment for all known risk factors (RII = 1.61, 95% CI: 1.07, 2.41), especially among nulliparous women.
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